WHAT'S UP DOC? Political decision impacts

Q: Does it seem like there have lately been a bunch of political decisions that have weakened health care for the poor?

A: There have been several political actions recently taken that may have strong negative implications for access to quality health care, specifically for the middle class and the poor.

The first one that jumps out is congress’s failure to renew the Children’s Health Insurance Program (CHIP). CHIP allows access to medical care for over 9 million low and middle-income children nationwide. It also covers over 350,000 pregnant women (in 18 states and the district of Columbia which have opted to include pregnant women) that otherwise earn too much to qualify for Medicaid. Although CHIP is paid for by both state and federal funds, federal funding covers the lion’s share of this incredibly important program.

We cannot lose this vital program. Note that per the CIA’s website https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html, in 2010 the United States ranked 136 out of 184 countries for maternal mortality (higher rank being better, so 48 countries are doing better than we are). We do a bit better for infant mortality (169 of 184 in 2016 per https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html), but that still means 15 countries are doing better than we are. The U.S. deaths noted in this data come disproportionately from people who are poorer, and so not renewing CHIP seems almost to guarantee that we will do even worse in the future.

The other big recent issue has been the aggressive undermining of the Affordable Care Act (ACA). Most experts would agree that there are many aspects of the ACA that should be improved. And either improving the ACA or repealing it with a replacement which is better are great options. But just undermining the ACA, specifically with an intentional effort to try to sabotage it, is simply playing politics and endangering the health and welfare of many Americans.

Health care insurance without certain provisions, including outpatient, emergency, hospital, maternal, newborn, pediatric, mental health, preventative and rehabilitation care, as well as medications and laboratory services, is just a bit of financial protection against a catastrophic illness, and not actually health care. Our goal must be to provide access to high quality, affordable health care:

For everyone, rich and poor. Just as we mandate and make available education for all American children, we need to provide affordable, quality health care for all Americans.For patients who have a pre-existing condition.That includes wellness care to keep people healthy, not just to treat illness once it has manifested.With no lifetime or annual limits.

The recent Presidential order seems to intentionally undermine this. Despite all the hype we hear about the excellence of medical care in the United States, the data is pretty clear. There are 41 countries with a longer life expectancy for their people than the U.S. (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html). This is despite the fact that we spend more on health care than any other nation on the planet (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2225rank.html).

Our elected politicians need to remember that they represent the people, all the people. Tens of millions of Americans now have health care (actual access to care of their health) that did not have it 10 years ago. We need to build on this, not reverse it.

We need to open our minds to improving our health care delivery system. There are at least 10 different health care models (in Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom) that are providing better quality and access to health care for their people than we are, at much lower cost. We need to look at these models and pick the strengths of them to create health care in the U.S. that is second to none.

It is completely irresponsible and reprehensible to be playing politics with the health of our countrymen, yet that seems to have become the common game that both Congress and the President seem to be playing. For the health and wellbeing of our neighbors, relatives and friends, we all need to urge our politicians to put politics aside and to work to improve access, cost and quality of health care in the U.S.